Ambulatory surgery centers built their reputation on predictability: fixed rooms, familiar teams, cases that start when they’re supposed to start. That model gets harder to protect the moment a center adds specialties, and 2026 is pushing more centers in that direction. CMS finalized its Calendar Year 2026 rule with more than 500 additional procedures on the ASC Covered Procedures List, a change the agency estimates will affect roughly 6,000 Medicare-certified ASCs. That includes cardiac ablation codes and a large batch of musculoskeletal procedures moving off the inpatient-only list as part of a three-year phaseout.
Industry analysts covering 2026 ASC trends point to a related shift: health systems and independent groups are leaning into multi-specialty models to diversify volume and spread fixed costs across a broader case mix. That means the specialty mix on next year’s schedule may look nothing like this year’s, and multi-specialty ASC scheduling isn’t single-specialty scheduling with more names on the block calendar. It’s a different operational problem, one where surgeon preference and fixed OR capacity pull against each other in ways a generic policy won’t solve.
OR Time Isn’t the Only Resource in Play
In a multi-specialty ASC, two open hours on the schedule aren’t automatically interchangeable. An orthopedic case may need a specific table, positioning equipment, implants, vendor coordination, or staff experienced with that procedure. An ophthalmology case is typically shorter with its own turnover pattern. A GI case comes with its own patient selection, preparation, and staffing requirements. Capacity, in other words, is about more than available OR minutes. It also depends on whether the center has the right room, equipment, supplies, staffing, and anesthesia coverage lined up for the cases actually being scheduled.
Patient selection is part of that same picture. One ASC’s quality-improvement project, featured by ASGE as part of its Endoscopy Unit Recognition Program, reviewed patient complexity against the center’s own criteria before scheduling, with CRNAs checking medical history, medications, and prior testing. Over the study period, that cut the number of patients requiring same-day cancellation or relocation to a hospital setting from five to one.
A procedure becoming newly eligible for Medicare payment in the ASC setting, as CMS’s 2026 expansion allows for hundreds of additional codes, doesn’t mean it’s automatically the right fit for every center or every patient. Facility capabilities and individual patient needs still decide what belongs on a given day’s schedule.
Staffing is often the tightest part of that equation, especially as a broader case mix means recruiting for more specialty-specific roles at once, from certified surgical techs experienced with orthopedic implants to endoscopy-trained RNs. Centers filling those gaps can look beyond general healthcare job boards to the ASC Job Board, a recruiting platform built specifically for ambulatory surgery roles.
A Single Block Policy Doesn’t Fit a Multi-Specialty Case Mix
When every surgeon in a center performs similar procedures, block utilization tends to cluster in a fairly narrow range. Add gastroenterology, ophthalmology, orthopedics, pain management, and general surgery under one roof, and that range widens fast.
HST’s 2026 State of the ASC Industry Report, built from 682 ASCs across 45 states, shows block time utilization by specialty in 2025 running as follows:
- Gastroenterology: around 60%
- Ophthalmology: 56%
- Dental/Periodontal: 54%
- Urology: 51%
- Spine: 22%
- General surgery: 19%
Cardiovascular stood out as the specialty with the most dramatic shift, climbing from the low 20% range in 2023 to well above every other specialty on this list by 2025, reflecting the broader push of cardiac procedures into the ASC setting. This year’s report also breaks out total joint and spine as their own categories rather than folding them into orthopedics, so the specialty list isn’t a direct match to prior editions.
Most administrators aim for a block utilization goal somewhere between 70% and 90%. A center-wide average sitting comfortably inside that range can mask specialties running well below it and others running over capacity. Reviewing utilization by specialty, rather than as one blended number, shows where the difference actually is.
Turnover Time and Block Release Timing by Specialty
Turnover time increases slightly when specialties switch in the same room, but next-case tardiness doesn’t move much. A 2019 study in the Journal of Clinical Anesthesia looked at cases where a different surgeon operated in the same room right after another case, and found that turnover time was longer when the two surgeons were in different specialties. Still, the resulting difference in mean tardiness of the next case’s start was about 0.1 minutes, not statistically significant. For scheduling purposes, mixing specialties in the same room over the course of a day does not, on its own, meaningfully delay the cases that follow.
Block release timelines work best when they reflect how far in advance each specialty typically books, rather than one rule applied to every surgeon. Orthopedic and bariatric cases are commonly scheduled well in advance, while general surgery cases often come together closer to the date. A single release window, say 48 or 72 hours, applied evenly across all specialties tends to suit shorter lead-time cases better than longer lead-time ones, which can lose their blocks before they’ve had a chance to book.
Turnover data can also be misleading if it isn’t broken down by case type. One hospital-based facility found that its high volume of cataract cases was skewing its overall turnover average, making it hard to see how the rest of its mix, including more complex GI and orthopedic cases, was actually performing. Reviewing turnover time by specialty, rather than as one center-wide number, gave a clearer picture.
A Practical Framework for Balancing Preference and Capacity
Specialty-level data makes this balance easier to manage. A few ways to bring it in:
- Track utilization by specialty and by surgeon, not just as a center-wide figure. That’s where you’ll find which physicians are consistently under their block and which specialties are quietly capacity-constrained.
- Set release windows around how each specialty actually books, rather than applying one rule everywhere. A center running ophthalmology and orthopedics side by side may need two different release timelines to serve both fairly.
- Use your center’s own case-duration data instead of generic estimates. Actual duration varies by procedure, surgeon, anesthesia approach, and equipment needs, and inaccurate estimates are a recognized driver of late-running schedules and lower OR utilization. Comparing scheduled to actual time by specialty, and adjusting templates when a pattern holds, keeps the schedule realistic instead of pushing the same problem into the next case.
- Sequence cases with shared equipment in mind. When two rooms need the same piece of equipment on the same day, such as a microscope, sequencing cases so the timing doesn’t conflict protects both the equipment’s use and the day’s overall utilization.
- Watch on-time starts by specialty as an early warning sign. Our 2024 data shows surgeries were delayed by an average of 15.4 minutes across specialties, with general surgery cases running the longest at 27.2 minutes and ENT among the shortest at roughly eight minutes. The gap can close: a 2025 case study published in AORN Journal described one ASC that raised its first-case on-time-start rate from 30% to 79% over a year by tracking causes of delay and adjusting its process.
- Bring surgeons into the conversation with their own data in hand. Sharing a surgeon’s own utilization trend alongside any proposed change gives them the same information you’re working from.
- Ask why a block is running low before assuming the surgeon doesn’t need the time. Administrators frequently find that a physician’s office scheduler called another facility first simply because booking there felt faster or more familiar, not because the surgeon’s demand for OR time actually dropped. In a multi-specialty center juggling several practices with different booking habits, making your own scheduling process the easy choice matters as much as the policy itself.
Where the Right Tools Help
Good scheduling software won’t resolve a preference conflict on its own, but it removes a lot of the friction around finding out where one exists. Look for:
- Real-time block utilization data, broken out by specialty and by surgeon
- Automated release rules that open unused time before it’s wasted, including recurring blocks that release automatically on a set schedule
- Conflict flags that catch double-booked blocks before they happen
A system built to give schedulers and physician offices the same picture at the same time is where most of these disagreements get resolved before they start.
Multi-specialty growth isn’t slowing down, and the 2026 expansion of ASC-eligible procedures adds even more variety to the case mix administrators are managing. None of this is a one-time fix, either. Surgeon volumes shift, new physicians join, procedures continue moving into the outpatient setting, and this year’s case mix may look different again next year. Specialty-level data on block utilization, case duration, turnover, and on-time starts give you a clearer, more current basis for balancing surgeon preference with OR capacity than a policy set once and left alone.
If you’d like to see how a specialty-aware scheduling setup could work for your center, schedule a demo with our team.